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Learn About Key Coverage in the Patient and Affordable Care Act

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Did you know the uninsured rate in the fourth quarter of 2017 was 12.2 percent, almost the same as the 12.3 percent rate the survey found in the third quarter? But it’s up from a low point of 10.9 percent recorded in the quarter of 2016. The uninsured rate us down from its peak of 18 percent in the third quarter of 2013, shortly before Obamacare’s subsidized exchanges opened. Let us share six key insights on health care coverage with you in our blog.

 

  1. Young Adult Coverage

Group health plans and health insurers offering group or individual health insurance with dependent child coverage must make available optional coverage for the enrollee’s dependent adult children who are younger than age 26. The coverage must be provided even if the child is married or disabled. The child does not have to be a student.

 

  1. Unlimited Coverage

Group health plans and health insurers offering group or individual health insurance may not impose limits on benefits or caps. The new rules are not construed in preventing the coverage from imposing an annual or lifetime per beneficiary cap on specific covered benefits that are not considered “essential health benefits.”

 

  1. Pre-Existing Condition

The Patient and Affordable Care Act ended the medical underwriting and pre-existing condition exclusions. Insurers are prohibited from denying coverage or setting rates based on health status, medical conditions, claims experience, genetic information, evidence of domestic violence, or other health-related factors.

 

  1. Non-Rescission

Group health plans and health insurers offering group or individual health insurance may not rescind an insured’s coverage once it is issued, except for fraud or intentional misrepresentation of material facts. Such coverage may not be cancelled without prior notice to the enrollee. However, mandatory renewal or continued coverage is not required if premiums are not paid or are paid untimely or that type of coverage is no longer provided in the market.

 

  1. Non-discrimination

The health insurance benefits provided to highly compensated employees must be provided to all other employees. However, the group insurance plan can exclude employees who have not completed three years of service or who are part-time or who are under 25 year of age.

 

  1. Required Coverage

The Affordable Care Act initially required nearly every resident of the United States to obtain minimum health insurance coverage by January 1, 2014 or to be exempt. The deadline was extended to March 31, 2014. Minimum essential coverage is not required for the individual and his or her dependent(s) covered under either Medicare Part A, Medicaid, the Child Health Insurance Program, Tricare, Veteran’s health care, an employer sponsored plan, an individual plan or the Health and Human Services’ plan or a state risk pool.

 

Need to learn more? Have questions? Do not wait to let us know!